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Prescribing antidepressants for elderly persons should not be affected by concern about drug-related pneumonia risk

A recent study found that elderly patients were three times as likely to be hospitalized for aspiration pneumonia in the 3 months following a hospitalization for depression compared with 3 months prior to hospitalization. This led to concern that elderly use of antidepressants might increase their risk of aspiration pneumonia (pneumonia caused by inhalation of food, vomit, or liquid).

A new study reveals that hospitalization for pneumonia and aspiration pneumonia was 1.6 and 1.45 times, respectively, as common among elderly antidepressant users. However, after adjustment for other factors such as chronic neurologic and pulmonary conditions (previously implicated as risk factors for pneumonia), use of other prescribed drugs, other hospitalizations, and other factors, antidepressants (both the more sedating tricyclics and the newer selective serotonin reuptake inhibitors) did not seem to increase hospitalization for pneumonia.

Also, patients prescribed antidepressants suffered from pneumonia during the expected wintertime peak in late January typical of elderly persons not taking antidepressants (controls). Thus, decisions to prescribe antidepressants in elderly persons should not be affected by concern about pneumonia risk, conclude Sean Hennessy Pharm.D., Ph.D., Center for Clinical Epidemiology and Biostatistics, Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Center, and Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, and William B. Baine, M.D., of the Agency for Healthcare Research and Quality.

Drs. Hennessy and Baine and colleagues analyzed 12,044 cases of hospitalizations for pneumonia and 48,175 controls from a database of medical records from about 2,000 general practitioners in the United Kingdom from 1987 to 2002. They also identified 159 cases of hospitalization for aspiration pneumonia and 636 controls. The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-005-004).

See "Observed association between antidepressant use and pneumonia risk was confounded by comorbidity measures," by Sean Hennessy, Pharm.D., Ph.D., Warren B. Bilker, Ph.D., Charles E. Leonard, and others, in the September 2007 Journal of Clinical Epidemiology 60, pp. 911-918.

Reprints (AHRQ Publication No. 08-R011) are available from the AHRQ Publications Clearinghouse.

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